Listening to industry: what’s the ROI of medical education?

In the ongoing debate over industry influence in medicine, who should you believe, the critics or the defenders of industry? The answer is easy: the industry defenders. Just listen to what the defenders say when they’re talking among themselves.

For example, listen to Bill Cooney, President & CEO of Medpoint Communications, which is, in its own words, “a global leader in diversified communications services for leading pharmaceutical and biotechnology companies.” Cooney recently answered questions about virtual speaker programs in the “Ask the Experts” section of MedAdNews. Pay close attention to what he says:

MedAdNews: What is the range for return on investment for speaker Webcasts?

Cooney: First, be cautioned that several pharma and biotech companies have discontinued assessing ROI on speaker programs because they do not want to create a link between peer education activities and a “profit motive,” which they believe may trigger a legal/regulatory risk. Following that same cautious reasoning, my firm refrains from directly connecting speaker programs to ROI, although we work with some pharma and biotech companies who have assessed ROI for their virtual speaker programs….
The bottom line is that, if you can lower costs by two-thirds and maintain effectiveness, ROI is increased by 300%. And lowering the cost of speaker programs is not just good business, but it’s also good in terms of ethical marketing and public perception.

So, Cooney won’t do the math, but if you ask nicely you’ll get the answer: a 300% increase in ROI.

Here’s another interesting paradox. If you thought the Physician Payment Sunshine Act was going to shake things up, think again:

Cooney: …the Physician Payment Sunshine Act (PPSA) has recently become law and goes into effect over the next two years. The PPSA sets reporting requirements at $10 per transaction or $100 annually per physician for “payments of value” which includes meals. One result is that attendees to dinner meetings will have their name and the value of the meal reported on a public website, which may be a disincentive for many HCPs to attend dinner meetings. Virtual meetings that eliminate meals will also eliminate the PPSA reporting requirement.

Finally, Cooney is very clear about the precise relationship between the speaker content and the duties of the sales reps:

MedAdNews: Is it possible to conduct speaker Web conferences in the physician’s office without distracting sales reps from their sales duties?

Cooney: …this hinges on virtual program design, so that “the program supports the rep,” instead of “the rep supports the program.”

Cooney then recommends that pharma reps try to set up virtual webcasts in the physicians’ own offices, for a very important reason:

Cooney: To make these programs easy for pharma reps, think about having HCPs join using computers that are already in the clinic, such as a desktop computer in the HCP’s office. This way the rep has no equipment to set up, and the activity moves from the break room into the HCP’s office. That won’t happen in every HCP office, but when it does, the pharma rep gets invaluable time with the HCP.

As I said earlier, if you’re trying to understand the relationship of industry and medicine, the first thing you need to do is to pay close attention to what industry is actually saying. Thanks to Bill Cooney for generously providing this valuable insight into the thinking that goes into medical communications.

Comments

  1. Gerry Hartung says

    The title of this article is somewhat misleading in that I do not believe Medpoint is a certified continuing medical education company and therefore cannot provide certified medical education. They may use the word “education” in referring to their business but they are not accredited to do this. They are in-fact a marketing/communication company and do not need to live up to the rigor of certified medical education. This is like any marketing firm informing you they want to ‘educate’ you about their companies product— just because they use the word education, doesn’t make them an educational insitution.
    We in the certified CME business are often “lumped in” with these types of marketing/communication firms simply because they use the word ‘education’ very lossely. With that said our industry (Certified CME) needs to do a better job educating the public– and the media of the difference between the two— and there is a world of difference.

  2. Bill Cooney says

    As the “industry defender” cited in this blog, I’d like to clarify a few things.

    1. My column, quoted above, does not have anything to do with CME. Rather, I discuss a whole different animal: within-label, company-sponsored speaker programs. My column is accessible only through an industry e-newsletter, and everyone within industry understands the category. I use the word “education” just once, as in “peer education activities,” but I use the terms “virtual speaker program,” “peer-to-peer programs,” and “speaker events” 20 or 30 times. I don’t know how any reasonable person could possible think I’m referring to CME in my column.

    2. Regarding ROI, I think it’s pretty clear that I’m a “defender” of NOT linking ROI to within-label speaker programs. Is that a bad thing? I also simply make the point that whatever the ROI, using virtual formats lowers overall costs by 67%. This is presumably in-line with the goals of “industry critics” that drug companies should lower overall spending on promotion so drugs can be made more affordable. To my complete bafflement, Mt. Husten implies that my comments on lowering costs are somehow a bad thing.

    3. Regarding the Physician Payment Sunshine Act, I speculate that the Act may disincent physicians to attend dinner meetings, and I offer up that this may lead to more virtual speaker programs. Clearly, this means that industry would NOT be providing free dinners, but instead would provide virtual meetings that focus on the speaker and medical information. Once again, I would think that industry critics would see the elimination of dinner “gifts” is as a good, not bad, thing. And I think that is “shaking things up” quite a bit!

    4. Regarding the final two points raised by Mr Husten above, it’s important to remember that all my comments have to do with within-label speaker programs, not CME. So the “content” Mr. Husten mentions is FDA regulated, and has no relationship with the “duties of the sales rep” as he states. These programs are defined by the FDA as promotional activities, and they are one of the informational resources that sales reps offer to physicians. Mr. Husten uses the quotes “the program supports the rep” and “the pharma rep gets invaluable time with the HCP” with an implication these comments are revealing some hidden agenda on the part of industry. These speaker programs invariably include full disclosure to all physicians that they are directly sponsored by industry and can only present within-label information; it’s abundantly clear this is not independent CME. Although these are overtly company-sponsored programs, they include distinguished speakers and are valued by the physicians who chose to attend. These programs are among the best examples of industry bringing “good” value to physicians in the form of peer education (dare I use the word?) that must reflect fair balance on safety and other issues, as regulated by the FDA. Again, I’d expect that industry critics would much rather see pharma bring this kind of value to physician offices, instead of free meals.

    I have a lot of respect for the viewpoints of many industry critics, and much of the reform towards more ethical marketing practices over the last decade has been beneficial and often fueled by the critics. But industry critics needs to resist the temptation to interpret everything they see as wrong-doing, and confuse meritorious actions by industry with vaguely subversive schemes, as Mr. Husten so clearly implies.

    To address the comment by Mr. Hartung, you’re right, MedPoint is NOT a CME provider! We don’t claim to be, not even close, and if you or others are confused, it may be because Mr. Husten fails to make the distinction when he talks about “the ongoing debate over industry influence in medicine,” which has often been a debate about CME.

    For the record, two years ago our company divested PeerPoint Medical Education Institute, LLC, which now is an independent company with no connection to MedPoint. Since that time, PeerPoint has been re-accredited by the ACCME under the latest, most rigorous accrediting regime. PeerPoint achieved re-accreditation “with distinction,” the highest category of accreditation received by only 5% of CME providers. I am very proud that I had a hand in founding PeerPoint over a decade ago, and if you wish to take a look at PeerPoint programs, I am sure you will find that its education activities greatly benefit the medical community, devoid of any bias to industry, with no involvement by pharma sales reps. That’s not to say that Mr Husten won’t imply that something dark and subversive is going on at PeerPoint, too.

  3. Dear Mr. Cooney– Thanks for your long and thoughtful response. I am sorry if anyone reading this made the assumption that you were talking about CME activities.

    Nevertheless, the fundamental points remain unchanged. If this is not CME it is still a type of education, and the fact that you utilize speakers with academic credentials and thought leaders is hard proof of this. The real problem here is that industry should not be involved in educating or training physicians in any direct way. With CME it’s worse because there is a pretense of objectivity that is simply not the case.

    I take your point about virtual programs doing away with the problem of industry-funded meals. But the meals were never the real problem, only a symptom. And virtual programs have the virtue– from industry’s point of view– of being less likely to attract notice or bad publicity. Or so they think.

    Regarding the main point about return on investment (ROI): you can slice and dice this however you like but there’s still a cat-and-mouse game going on here. Just because industry isn’t allowed to calculate the ROI of a speaker program doesn’t mean that they are not intensely interested in the ROI, or, in fact, that the ROI is not the essential motivation for the program. It was this aspect of your interview that first caught my eye and why I thought it might be of interest to my readers. Are you seriously willing to argue that industry-funded events are not ultimately motivated by the business purposes of the companies?

    I will be very happy to continue this discussion and debate if you are willing.

    Best,

    Larry

    • Bill Cooney says

      Mr. Husten – I do think the headline of “… the ROI of medical education” is misleading to readers because “medical education” strongly implies CME. I didn’t use the term “medical education” once in my column. I think these distinctions in terminology are not just parsing, but quite important. The entire rest of your criticism of ROI is set upon the false premise that I am discussing medical education. I’m not implying that you purposely made this error, but I think it matters and you should consider correcting it.

      Legally and quite overtly to the faculty and audience involved, speaker programs are sponsored, within-label activities, not independent medical education. The FDA does not view them as any less susceptible to regulation than journal advertising or sales rep promotion.

      Counter to what you say above, industry IS allowed to calculate ROI for speaker progams. I am aware of no legal or regulatory prohibition. Most companies voluntaily refrain from doing so out of an excess of precaution, as they do with so many practices these days.

      You evidently believe that speaker programs are conducted with a false pretense that they are “medical education” and I can understand your concern..These programs involve speakers with academic credentials, and in some ways are similar to indepedent education. In the past, the line was not always so clearly drawn with some CME activities. The blurring of lines between CME and promotion has been massively reformed and stopped happening about 8 years ago. It’s unfortunate that it occurred, and perhaps the distrust among you and others is due to this legacy.

      But I disagree that, today, industry plays a “cat and mouse game.” Should you familiarize yourself with how these programs are currently conducted, you’ll find that sponsors go out of their way to clarify that these are not independent education, but rather, within-label, company-sponsored events. It’s made very clear, and physicians are smart enough to understand the difference. It’s really not fair to accuse industry of engaging in deception.

      To address the question you pose, yes, I do think industry-funded events are motivated by business purposes. Those purposes include building positive relationships with the medical community, as well as supporting product sales, without which they have no business.

      I’d like to ask you, what’s so inherently bad about ROI? I believe that one can “do well by doing good” and both profit while benefitting other parties in non-monetary ways. I think that today, speaker programs are generally great examples of that win-win. The opposing school of thought is that the profit motive generally corrupts and excludes good deeds. Perhaps that difference is why you and I won’t see eye-to-eye on this issue.

  4. Mr. Cooney,

    I want to thank you again for the thoughtful tone of your remarks. It’s nice to engage in a debate that doesn’t sound like a Cable news screamfest.

    Nevertheless, I feel compelled to dispute the underlying basis of your argument. If I understand correctly, you are arguing that “sponsored, within-label activities” are completely distinct from “independent medical education.” Although problems may have existed in the past in both these categories, you appear to believe that these have now been largely resolved, and that promotional programs conform to reasonable and appropriate regulatory restrictions while supporting the legitimate business activities of its sponsors, and that industry-supported CME programs exist independently of the commercial interests of companies and contribute significantly to the medical education needs of practicing physicians.

    I disagree with both sides of the proposition. My main point is that promotional activities are “successful” to the degree that they emulate legitimate education programs, and that CME programs are “successful” only to the degree that they support the commercial interests of the sponsor. I will make only a few key points right now.

    Regarding sponsored activities, I have little problem with advertising, promotional literature, etc. I believe quite strongly that pharmaceutical and device companies should profit from their products. But I don’t believe that academic and practicing physicians should be involved in any way with these promotional activities or that they should be compensated for speaking or writing on behalf of industry products. Quite simply, the interests of academic and practicing physicians should be 100% aligned with the interests of their patients. By engaging in promotional activities physicians are inevitably compromised. And, it follows, physicians should not listen to their colleagues who are paid to speak on behalf of a product or a company. Whether these activities occur at a dinner at an expensive restaurant or in the physicians’ office computer (with or without a sales rep by the side) makes little difference.

    Regarding CME, although some of the worst abuses have indeed been curtailed, there is no question that CME continues to serve primarily as a marketing tool for industry. I do not argue that all CME is pure marketing, or that good CME programs don’t exist. But I do argue that the fundamental reason for the existence of the vast proportion of sponsored CME programs is to provide marketing support for commercial products. In addition to the commercial purpose of CME programs– as evidenced by the astonishing ~ $1 billion spent each year by industry on it– CME has several additional, pernicious side-effects that seriously damage contemporary medical culture.

    The first side effect is the impact of CME on the agenda of medical education. The overwhelming vast majority of commercially supported CME is product-related and squeezes physicians into the uncomfortable and unnatural role of pill pushers or device implanters. Medicine– and therefore medical education– needs to be much more than that.

    The second side effect is the impact of the showering of CME dollars on physician finances. For many physicians who are frequent CME speakers, the income boost helps alleviate the depredations associated with the (relatively) low wages of academic medicine. As the CME income becomes vital to pay for the the college tuition and the like, the independence of the physician is threatened. How likely is it that a physicians critical of a product will continue to receive speaking fees from that company? (I should also point out that the near complete absence of industry critics in CME programs is perfect evidence of why, in fact, commercial CME is biased. If it were truly unbiased it would fully embrace its critics!)

    I’ll stop for now, but will be happy to continue this interesting debate.

    Best,

    Larry

  5. Bill Cooney says

    Larry,

    Your description above on how we disagree is fair enough. I believe that a wide and appropriate gulf exists currently between CME activities and promotional activities of pharma companies. You don’t. I perceive that the great majority of CME programs are truly independent, balanced, and quite beneficial to clincians. You disagree.

    I’ll grant you that pharma companies tend to fund activities is disease states in which they have a commercial interest, but they also routinely fund CME activities with no commercial relevance. But it is reasonable to say that pharma funding skews the mix of all CME offered to certain disease states. It’s also true that, with an explosion of options since the advent of the web, clinicians can get CME on almost any clinical topic they seek. Eliminating commercially-supported CME won’t create better CME for under-served topics, it will just reduce choice and take away some excellent programs.

    I’ll also grant you that, in a small fraction of cases today, bias can and does occur in CME programs. That will probably never go away entirely, and the critics, like you, should keep up the pressure. But anyone in the field can attest to how fundamentally different and better CME is today than a decade ago. And the audience for CME is on the look-out, so biased programs, I believe, are self-defeating.

    Your point about physicians becoming financially dependent on speaker income is fair and important. There should be strict limits on annual payments, and there are at almost every pharma company, but it’s still a concern. I think this concern is reasonably constrained by conducting truly independent CME, by the preceptiveness of physician audiences, and ultimately, by the personal integrity of those invoved.

    In the real world, commercially supported CME will never be perfect, but can be (and I think is) very good. It boils down to costs versus benefits: Is the US medical community better off with or without commercial support of CME? It’s clear where we both stand on that question.

    But we also disagree on how to resolve the concern over bias creeping into CME. You advocate a regulatory solution, banning commercial support, so that physicians are protected from being manipulated. I endorse a free-market solution so that, as long as there is open disclosure and reasonable oversight of CME providers, physicians don’t need to be protected by a ban imposed by their peers from on high. Poll after poll has shown that an over-whelming majority of US physicians want commercially-supported CME. I say, let individual physicians make the final judgement on the merits of commercially supported CME, with their feet.

    Bill

  6. Bill, you may not be aware but I’ve moved this thread to a separate blog post to make it more readily accessible to readers. I’m going to start a new thread with your most recent message, with links to the earlier threads.

    Larry

Trackbacks

  1. […] Posted on August 27, 2010 by Larry Husten Editor’s note: Back in June (Listening to industry: what’s the ROI of medical education?) I commented on some statements made by Bill Cooney, the President & CEO of Medpoint […]

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